Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts
Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
Defines coverage and medical necessity stance for cryoablation, radiofrequency ablation, and laser ablation to treat chronic (allergic or nonallergic) rhinitis for Blue Cross Blue Shield - Rhode Island members.
No material clinical or coverage changes in this revision.
Coverage Determinations
Coverage stance
Policy coverage determinations
The following procedure codes are excluded from coverage for Medicare Advantage Plans and are considered not medically necessary for Commercial Products when submitted with the listed ICD-10-CM diagnosis codes: 31242 (Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve — New Code Effective 1/01/2024), 31243 (Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve — New Code Effective 1/01/2024), and C9771 (Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral — Code Deleted Effective 12/31/2023).
For Commercial Products, cryoablation, radiofrequency ablation, and laser ablation to treat chronic rhinitis (allergic or nonallergic) are considered not medically necessary because the evidence is insufficient to determine the effects of these technologies on health outcomes.
Procedure and Diagnosis Codes
| 31242 | Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve (New Code Effective 1/01/2024) |
| 31243 | Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve (New Code Effective 1/01/2024) |
| C9771 | Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral (Code Deleted Effective 12/31/2023) |
| J30.0 | Vasomotor rhinitis |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| J31.0 | Chronic rhinitis |
Provider Requirements, Billing, and Member Liability
Prior authorization not applicable
Prior authorization is not required for services addressed in this policy; prior authorization is listed as not applicable.
Verify benefits and eligibility
Verify member-specific benefits and eligibility before providing services, because benefits and coverage are determined by the member's subscriber agreement or employer agreement.
- For member-specific benefit questions, contact the provider call center as noted in the policy.
Require prior medical management (pharmacotherapy)
Attempt and document adequate medical management (pharmacotherapy such as topical steroids, anticholinergics, decongestants, or antihistamines) prior to considering posterior nasal nerve ablation; ablation is intended for refractory chronic rhinitis after failure of adequate medical therapy.
- Adequate medical therapy is referenced in the policy as the initial treatment and defines refractory cases when symptoms persist despite therapy.
Policy coverage stance — not covered / not medically necessary
Be aware that cryoablation, radiofrequency ablation, and laser ablation for chronic rhinitis are considered not covered for Medicare Advantage and not medically necessary for Commercial products according to this policy.
- Specific CPT/HCPCS codes listed as not covered or not medically necessary will trigger denial or nonpayment when filed with the referenced ICD-10-CM codes.
Billing guidance — use unlisted procedure codes if no CPT/HCPCS exists
When a specific CPT or HCPCS code is not assigned for the service provided, bill using the appropriate unlisted procedure code as specified in the policy.
Benefits verification and informed consent for non-covered services
Verify member benefits and eligibility with the provider call center prior to performing services; if the service is determined to be not covered or not medically necessary and the member elects to proceed, document written informed consent acknowledging member financial responsibility.
- Contact the provider call center for member-specific benefits.
- Document the member's written agreement if they will be financially responsible for non-covered or not medically necessary services.
Denial consequences and member financial liability
If a service is determined to be not medically necessary (or is medically necessary but is a non-covered benefit), the provider may not charge the member unless the member was informed in advance and agreed in writing to assume financial responsibility.
- Refer to participation agreement(s) for applicable provisions regarding member billing.
- Document written member agreement prior to proceeding if the member will pay for non-covered services.
Clinical Background
Chronic rhinitis encompasses allergic, nonallergic, and mixed forms and is commonly managed initially with pharmacologic therapy such as topical intranasal corticosteroids, anticholinergic agents, decongestants, and antihistamines. Approximately 10%–22% of patients may have persistent symptoms despite medical therapy and be considered refractory. For refractory cases, procedures that interrupt parasympathetic innervation to the nasal mucosa — including surgical approaches (for example, vidian neurectomy) as well as minimally invasive techniques targeting the posterior nasal nerve such as cryoablation, temperature-controlled radiofrequency, or laser ablation — have been developed to reduce glandular secretions and nasal blood flow.
Definitions and Key Terms
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.